Diagnostic accuracy of rest/stress ECG-gated Rb-82 myocardial perfusion PET: Comparison with ECG-gated Tc-99m sestamibi SPECT
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Although single photon emission computed tomography (SPECT) and positron emission tomography (PET) myocardial perfusion imaging (MPI) have evolved considerably over the last decade, there is no recent comparison of diagnostic performance. This study was designed to assess relative image quality, interpretive confidence, and diagnostic accuracy by use of contemporary technology and protocols.
Methods and Results
By consensus and without clinical information, 4 experienced nuclear cardiologists interpreted 112 SPECT technetium-99m sestamibi and 112 PET rubidium-82 MPI electrocardiography (ECG)-gated rest/pharmacologic stress studies in patient populations matched by gender, body mass index, and presence and extent of coronary disease. The patients were categorized as having a low likelihood for coronary artery disease (27 in each group) or had coronary angiography within 60 days. SPECT scans were acquired on a Cardio-60 system and PET scans on an ECAT ACCEL scanner. Image quality was excellent for 78% and 79% of rest and stress PET scans, respectively, versus 62% and 62% of respective SPECT scans (both p < .05). An equal percent of PET and SPECT gated images were rated excellent in quality. Interpretations were definitely normal or abnormal for 96% of PET scans versus 81% of SPECT scans (p = .001). Diagnostic accuracy was higher for PET for both stenosis severity thresholds of 70% (89% vs 79%,p = .03) and 50% (87% vs 71%,p = .003) and was higher in men and women, in obese and nonobese patients, and for correct identification of multivessel coronary artery disease.
In a large population of matched pharmacologic stress patients, myocardial perfusion PET was superior to SPECT in image quality, interpretive certainty, and diagnostic accuracy.
- Schwaiger M. Myocardial perfusion imaging with PET. J Nucl Med 1994;35:693–8.
- Tamaki N, Yorekura Y, Senda M, Yamashita K, Koide H, Saji H, et al. Value and limitation of stress thallium-201 single photon emission computed tomography: comparison with nitrogen-13 ammonia positron tomography. J Nucl Med 1988;29:1181–8.
- Gould KL. Clinical cardiac PET using generator-produced Rb-82: a review. Cardiovasc Intervent Radiol 1989; 12:245–51. CrossRef
- Stewart RE, Schwaiger M, Molina E, Popma J, Gacioch GM, Kalus M. Comparison of rubidium-82 PET and thallium-201 SPECT imaging for detection of coronary artery disease. Am J Cardiol 1991;67:1303–10. CrossRef
- Go RT, Marwick TH, MacIntyre WJ, Saha GB, Neumann DR, Underwood DA, et al. A prospective comparison of rubidium-82 PET and thallium-201 SPECT myocardial perfusion imaging utilizing a single dipyridamole stress in the diagnosis of coronary artery disease. J Nucl Med 1990;31:1899–905.
- Marwick TH, Go RT, Maclntyre WJ, Saha GB, Underwood DA. Myocardial perfusion imaging with positron emission tomography and single photon emission computed tomography: frequency and causes of disparate results. Eur Heart J 1991;12:1064–9.
- Klocke FJ, Baird MG, Lorell BH, Bateman TM, Messer JV, Berman DS, et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). J Am Coll Cardiol 2003;42:1318-33. CrossRef
- Bateman TM, Cullom SJ. Attenuation-correction SPECT myocardial perfusion imaging. Semin Nucl Med 2005;35:37–51. CrossRef
- Rothman KJ, Greenland S. Modem epidemiology. 2nd ed. Philadelphia: Lippincott-Raven; 1998.
- American Society of Nuclear Cardiology. Updated imaging guidelines for nuclear cardiology procedures, part 1. J Nucl Cardiol 2001;8:G5–58. CrossRef
- Cullom SJ, Meyer AF, Case JA, McGhie AI, Bateman TM, Preliminary evaluation of LSO-based PET for ECG-gating of rest/stress Rb-82 perfusion studies [abstract]. J Nucl Med 2002; 43:197P.
- Case JA, Bateman TM, Moser K, Cullom SJ, Hertenstein GK. Comparison of LVEF measurements from ECG-gated Rb-82 myocardial perfusion PET and Tc-99m sestamibi myocardial perfusion SPECT [abstract]. J Nucl Cardiol 2003;10:S13. CrossRef
- Hudson HM, Larkin RS. Accelerated image reconstruction using ordered subsets of projection data. IEEE Trans Med Imaging 1994;13:601–9. CrossRef
- Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002;105:539–42. CrossRef
- Siegel S, Castellan NJ. Nonparametric statistics for the behavioral sciences. 2nd ed. Montreal: McGraw-Hill; 1988.
- Hendel RC, Berman DS, Cullom SJ, Follansbee W, Heller GV, Kiat H, et al. Multicenter clinical trial to evaluate the efficacy of collection for photon attenuation and scatter in SPECT myocardial perfusion imaging. Circulation 1999;99:2742–9.
- Links JM, DePuey EG, Taillefer R, Becker LC. Attenuation correction and gating synergistically improve the diagnostic accuracy of myocardial perfusion SPECT. J Nucl Cardiol 2002;9:183–7. CrossRef
- Williams BR, Mullani NA, Jansen DE, Anderson BA. A retrospective study of the diagnostic accuracy of a community hospital- based PET center for the detection of coronary artery disease using rubidium-82. J Nucl Med 1994;35:1586–92.
- Bateman TM. Thallium-201: optimal utilization of the gold standard for myocardial perfusion imaging. In: The experts’ guide to nuclear cardiology. Secaucus, NJ:Thomson Professional Postgraduate Services; 2004. p. 7–12.
- Pennel DJ, Mavrogeni S, Forbat SM, Karwatowski SP, Underwood SR. Adenosine combined with dynamic exercise for myocardial perfusion imaging. J Am Coll Cardiol 1995;25:1300–9. CrossRef
- Jamil G, Ahlberg AW, Elliott MD, Hendel RC, Holly T, McGill CC, et al. Impact of limited treadmill exercise on adenosine Tc-99m sestamibi single-photon emission computed tomographic myocardial perfusion imaging in coronary artery disease. Am J Cardiol 1999;84:400–3. CrossRef
- Elliott MD, Holly TA, Leonard SM, Hendel RC. Impact of an abbreviated adenosine protocol incorporating adjunctive treadmill exercise on adverse effects and image quality in patients undergoing stress myocardial perfusion imaging. J Nucl Cardiol 2000;7:584–9. CrossRef
- Thomas GS, Pill NV, Majmundar H, Fabrizi RR, Thomas JJ, Hayashida C, et al. Treadmill exercise during adenosine infusion is safe, results in fewer adverse reactions, and improves myocardial perfusion image quality. J Nucl Cardiol 2000;7:439–46. CrossRef
- Cullom SJ, Case JA, Bateman TM. Attenuation collection in myocardial perfusion SPECT. In: DePuey EG, Garcia EV, Berman DS, editors. Cardiac SPECT imaging. Philadelphia:Lippincott Williams & Wilkins; 2001. p. 89–1022.
- Hendel RC, Corbett JA, Cullom SJ, DePuey EG, Garcia EV, Bateman TM. The value and practice of attenuation collection for myocardial perfusion SPECT imaging: a joint position paper from the American Society of Nuclear Cardiology and the Society of Nuclear Medicine. J Nucl Cardiol 2002;9:135–43. CrossRef
- Heller GV, Links J, Bateman TM, Ziffer JA, Ficaro E, Cohen MC, et al. American Society of Nuclear Cardiology and Society of Nuclear Medicine Joint Position Statement: attenuation correction of myocardial perfusion SPECT scintigraphy. J Nucl Cardiol 2004; 11:229–30. CrossRef
- DePuey EG, Rozanski A. Using gated technetium-99m-sestamibi SPECT to characterize fixed myocardial defects as infarct or artifact. J Nucl Med 1995;36:952–5.
- Taillefer R, DePuey EG, Udelson JE, Beller GA, Latour Y, Reeves F. Comparative diagnostic accuracy of Tl-201 and Tc-99m sestamibi SPECT imaging (perfusion and ECG-gated SPECT) in detecting coronary artery disease in women. J Am Coll Cardiol 1997;29:69–77. CrossRef
- Smanio PE, Watson DD, Segalla DL, Vinson EL, Smith WH, Beller GA. Value of gating of technetium-99m sestamibi single- photon emission computed tomographic imaging. J Am Coll Cardiol 1997;30:1689–92. CrossRef
- Heller GH, Bateman TM, and the Multicenter Investigators. Clinical value of attenuation collection in stress-only Tc-99m sestamibi SPECT imaging. J Nucl Cardiol 2004; 11:273–81. CrossRef
- Nuyts J, Dupont P, Van den Maegdenbergh V, Vleugels S, Suetens P, Mortelmans L. A study of the liver-heart artifact in emission tomography. J Nucl Med 1995;36:133–9.
- Bateman TM, Heller GV, McGhie AI, Friedman JD, Cullom SJ, Case JA. Attenuation-corrected Tc-99m sestamibi SPECT compared with Rb-82 myocardial perfusion PET [Suppl]. J Nucl Cardiol 2005;12:Sl18. CrossRef
- Glover DK, Ruiz M, Edwards NC, Cunningham M, Simanis JP, Smith WH, et al. Comparison between Tl-201 and Tc-99m sestamibi uptake during adenosine-induced vasodilation as a function of coronary stenosis severity. Circulation 1995;91:813–20.
- Cardiogen-82 [package insert]. Princeton (NJ): Bracco Diagnostics Inc. May 2002.
- Tc-99m-sestamibi [package insert]. Billerica (MA): Bristol-Myers Squibb Medical Imaging. May 2003.
- Bateman TM. Cardiac positron emission tomography and the role of adenosine pharmacologic stress. Am J Cardiol 2004;94(Suppl):19D-25DD. CrossRef
- Kapur A, Latus KA, Davies G, Dhawan RT, Eastick S, Jarritt PH, et al. A comparison of three radionuclide myocardial perfusion tracers in clinical practice: the ROBUST study. Eur J Nucl Med Mol Imaging 2002;29:1608–16. CrossRef
- Taillefer R, Amyot R, Turpin S, Lambert R, Pilon C, Jarry M. Comparison between dipyridamole and adenosine as pharmacologic coronary vasodilators in detection of coronary artery disease with thallium 201 imaging. J Nucl Cardiol 1996;3:204–11. CrossRef
- Levine MG, Ahlberg AW, Mann A, White MP, McGill CC, Mendes de Leon C, et al. Comparison of exercise, dipyridamole, adenosine, and dobutamine stress with the use of Tc-99m tetrofosmin tomographic imaging. J Nucl Cardiol 1999;6:389–96. CrossRef
- Machac J. Cardiac positron emission tomography imaging. Semin Nucl Med 2005;35:17–36. CrossRef
- Moser KW, Case JA, Bateman TM, Saunders MJ, Moutray KL, Cullom SJ. A quantitative comparison of 2D and 3D acquisition of Rb-82 myocardial perfusion PET studies on an LSO scanner [abstract]. J Nucl Med 2004;45(Suppl):222P.
- Diagnostic accuracy of rest/stress ECG-gated Rb-82 myocardial perfusion PET: Comparison with ECG-gated Tc-99m sestamibi SPECT
Journal of Nuclear Cardiology
Volume 13, Issue 1 , pp 24-33
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Single photon emission computed tomography
- positron emission tomography
- myocardial perfusion imaging
- Industry Sectors
- Author Affiliations
- 1. Cardiovascular Consultants, PC, 4320 Wornall Rd, Suite 2000, 64111, Kansas City, MO
- 2. Cardiovascular Imaging Technologies, LLC, Kansas City, Mo
- 3. Mid America Heart Institute, Kansas City, Mo
- 4. Division of Cardiology, Henry Low Heart Center, Hartford Hospital, Hartford, Conn
- 5. Cedars-Sinai Medical Center, Los Angeles, Calif